Breast or Bottle: Making the Choice

Breastfeeding

by T. Berry Brazelton, M.D., author of Feeding: The Brazelton Way

During the last 3 months of pregnancy, it is time to decide whether to breastfeed or bottle-feed. As a pediatrician, I like to have a prenatal visit with expectant parents during the seventh month of pregnancy. This is a good time to share such questions, because the process of birth and delivery are not yet looming large. Soon, though, they will be, and parents will have other concerns.

In this prenatal visit, I can get to know both parents without a baby between us. Each parent is likely to discuss his or her plans, wishes, and fears about becoming a parent. It can be a time for us to share their concerns and their hopes for the baby. All parents-to-be wonder, "How will I ever learn to be a parent? What kind of baby will I have?"

When I ask, "How do you plan to feed your baby?" it gives us a chance to discuss the decision to breastfeed or to use formula.

Benefits of Breastfeeding for the Baby

As a pediatrician, I am biased. The American Academy of Pediatrics recommends breastfeeding for 12 months. Among the reasons:

1. Breast milk is made for babies. Cow's milk is made for calves. While formulas today are as good as they can be and are fairly digestible, a certain number of babies will be allergic to cow's milk formula. I have never had a patient who was allergic to breast milk. A rare baby is sensitive to foods that the mother may eat and transmit in her breast milk. Usually these can be readily eliminated from her diet. But breast milk sensitivities are almost nonexistent. Cow's milk sensitivities may be difficult to detect initially. They may not show up as skin rashes or stomach upsets for several months. When a baby is allergic to cow's milk formula, it must be replaced with a substitute.
2. Breast milk provides the newborn with the mother's antibodies to protect the baby from infection. Colostrum, the cloudy liquid that precedes the breast milk by two or three days, is especially loaded with antibodies against infection. Breast milk is protective all through the period of breastfeeding, lowering the risk of ear infections, coughs, and colds. In fact, it also appears to protect babies against rashes and other signs of allergies.
3. You cannot overfeed your baby with breast milk alone—even if breastfed babies feed often and grow to appear "fat" in the process. A baby who seems to fatten on breast milk is likely to lose unnecessary fat after weaning. A baby does need to be weighed periodically by his pediatrician to be sure that he is receiving enough nutrition and growing as he should. Then you can relax and enjoy the times for nursing together!
4. Breast milk provides a baby with the nutrients he needs most in the first year. It even provides some of the digestive enzymes a baby needs to handle them. Even when mothers are malnourished, the nutritional value of breast milk is protected by nature. But, of course, a mother's diet will influence the levels of certain vitamins and minerals in breast milk.

Women who are breastfeeding should check with their doctors before taking medications, as some can pass from a mother's bloodstream into her breast milk.

A breastfeeding mother will need to drink enough fluids—2 or 3 quarts per day. She will also need to add at least 300 calories per day to the Recommended Dietary Allowances. (This can be done by adding one small meal a day, including a fruit, one vegetable, a piece of bread, a helping of meat or other high protein food such as cheese, nuts, or peanut butter, and two glasses of milk or other dairy products. These can be split up across the day instead, as added snacks. This is not the time for dieting!) But supplements will be important for some women who breastfeed. Women who are vegetarians should take a supplement with iron and vitamin B₁₂. Also, women who are unable to eat a balanced diet on a regular basis would do well to take a multivitamin supplement with iron while breastfeeding. Whether breastfeeding or not, women should continue taking iron supplements after delivery to rebuild their own iron stores.

Recently the American Academy of Pediatrics recommended a total minimum daily intake of 200 International Units of vitamin D for all infants, beginning within the first 2 months of life and continuing through childhood and adolescence. Once breastfed infants have been weaned and are taking in at least a pint of vitamin D-fortified milk or formula per day, they will not need supplements. Some infants will need iron supplements as well. Ask your baby's pediatrician about these supplements. Be careful, because your baby will need just the right amount. Too much vitamin D or iron can be dangerous!

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